Endoluminal Stent-Graft Repair in a Patient With Coarctation of the Aorta and Previous Iatrogenic Type B Aortic Dissection and Expanding Pseudoaneurysm

Abstract

To report endoluminal repair of aortic coarctation in a patient with a chronic type B aortic dissection presenting with an expanding pseudoaneurysm after failure of surgical repair. This 30-year-old man with a congenital coarctation of the aorta suffered an iatrogenic type B aortic dissection during angiography at the age of 6. Emergent surgery at that time included a left subclavian artery-to-distal thoracic aorta surgical conduit; the coarctation itself was not repaired. The patient presented 24 years after the surgery with a chronic distal extension of the dissection and a pseudoaneurysm severely compressing the aortic true lumen; the disrupted surgical conduit drained into the false lumen. In a novel approach, the true aortic lumen was intentionally occluded, and the surgical conduit was secured with stent-grafts to successfully exclude the pseudoaneurysm from the circulation. Type B dissection and coarctation of the aorta, in the setting of complex aortic pathology and comorbidities, can be treated with an endovascular approach.